Depression in Working Adults: Comparing the Costs and Health Outcomes of Working When Ill

作者：Cocker Fiona^*; Nicholson Jan M; Graves Nicholas; Oldenburg Brian; Palmer Andrew J; Martin Angela; Scott Jenn; Venn Alison; Sanderson Kristy

来源：PLos One, 2014, 9(9): e105430.

DOI：10.1371/journal.pone.0105430

Objective: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (%26quot;presenteeism%26quot;) amongst employed Australians reporting lifetime major depression. %26lt;br%26gt;Methods: Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). %26lt;br%26gt;Results: Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. %26lt;br%26gt;Conclusions: Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.

• 出版日期2014-9-2